Reversible Bevacizumab Induced Vocal Fold Necrosis

Area of Science:

• Oncology
• Otolaryngology
• Pharmacology

Background:

• Anti-angiogenic therapies are increasingly used for malignancies.
• Laryngeal side effects, including necrosis and dysphonia, are emerging complications.
• Bevacizumab is a potent systemic anti-angiogenic compound.

Purpose of the Study:

• To report two cases of laryngeal necrosis and dysphonia in patients treated with bevacizumab.
• To highlight the importance of recognizing and managing laryngeal complications of anti-angiogenic therapy.

Main Methods:

• Two patients with gynecological malignancies receiving bevacizumab therapy presented with severe dysphonia.
• Videostroboscopic examination revealed laryngeal ulcerations and eschar.
• Treatment involved bevacizumab discontinuation, vocal rest, and proton pump inhibitors.

Main Results:

• Both patients experienced improvement in voice and resolution of laryngeal eschar and ulceration after treatment.
• One patient had persistent shallow sulci and mild breathiness.
• Symptom onset ranged from 11-24 months after bevacizumab initiation.

Conclusions:

• Clinicians must be vigilant for laryngeal complications associated with potent anti-angiogenic drugs.
• The timing of symptom onset and reversibility can vary significantly among patients.
• Long-term voice sequelae may occur despite treatment.